Breast repair is a big deal. In the process of reconstruction, tissues of the back and front wall of the abdomen may be affected, the second mammary gland, if its shape needs to be adjusted.
- 1 When breast reconstruction is needed
- 2 What is it for
- 3 What determines the volume of plastic surgery during breast reconstruction
- 4 How can a removal be carried out?
- 5 How soft tissue is restored in the area of the removed breast
- 6 Ways to restore the nipple-areolar complex
- 7 Second Breast Correction
- 8 Contraindications for surgery
- 9 Preparing for an operation
- 10 Complications
- 11 Rehabilitation
When breast reconstruction is needed
Usually subject to restoration:
- the volume of skin and subcutaneous fat in the area of the removed mammary gland;
- the amount of tissue around the reconstructed mammary gland if adjacent tissues and pectoralis major muscle were removed during the mastectomy operation;
- nipple-areola complex;
- the shape and size of the second mammary gland can be adjusted to improve the appearance of the bust and eliminate asymmetry.
Of all the known methods of plastic surgery, almost any can be used:
- the use of ispander and breast endoprostheses;
- the movement of skin, subcutaneous fat and muscle in the area of the restored breast;
- laser polishing scars;
- tattoo of the areola area;
- In some cases, it is possible to use vacuum devices to stretch the skin in the area where breast reconstruction is performed after a mastectomy.
As you can see, for the reconstruction of the breast from a plastic surgeon requires a large number of skills, therefore, such work does not need to be trusted to unverified people.
What is it for
Lack of a mammary gland is not only a psychological problem. Although in most cases it is psychological discomfort that is the motivator for most patients who decide to undergo plastic surgery.
In addition to problems associated with the unaesthetic appearance of the bust after mastectomy, there may be:
- an imbalance in the load on the thoracic spine from two sides: where the mammary gland is preserved, the load will be greater;
- secondary changes in the osteoarticular system associated with an imbalance in the load on the spine, which are expressed as a violation of posture, drooping shoulders, curvature of the spine
- consequences of spinal curvature: impaired functioning of the chest organs – heart and lungs.
Therefore, after a mastectomy, this is not only a way to regain self-confidence, but also an excellent prophylactic against a number of chronic diseases of the cardiovascular and respiratory systems.
What determines the volume of plastic surgery during breast reconstruction
Not all patients of a plastic surgeon have breast restoration operations the same. Volume depends on a number of criteria.
- The volume of tissue removed during surgery for cancer.
Depending on the degree of cancer, different amounts of tissue may be removed.
The simplest situation is the removal of local formations with the preservation of a healthy part of the mammary gland. In this case, inverted scars and depressions are formed at the sites of removal of nodes and tumors.
All breast tissue can be removed while preserving the skin and subcutaneous tissue covering the mammary gland. Relatively easy option for subsequent reconstruction. Currently, this type of cancer surgery is rare. In most cases, it is used to prevent breast cancer in individuals with a genetic predisposition to the development of the disease.
Such an operation was performed on herself by Angelina Jolie, whose mother died at one time from cancer. Endoprostheses are installed in place of the removed glandular tissue. Complete removal of the breast is the most common way to remove breast cancer in women.
In cases where there is a risk of spreading metastases, the entire mammary gland, pectoralis major muscle, subcutaneous fatty tissue of half the breast are removed in order to remove the lymphatic vessels and lymph nodes to which lymph flows from the diseased breast. This option is the most difficult for the subsequent restoration of the bust and requires special skill of a plastic surgeon.
- The state of health of the patient.
The patient should be able to undergo another operation and anesthesia without complications. It should be borne in mind that contraindications to plastic surgery will be much more stringent than to surgery performed for health reasons (for cancer, for example). And that which did not prevent the surgical treatment of cancer in the past may become a serious contraindication for reconstructive surgery on the mammary glands.
- The appearance of the second breast and the client’s wishes regarding the future size and shape of the bust.
It only at first seems that after a mastectomy there is no life. Over time, during the pondering and discussion with the plastic surgeon of the details of the upcoming reconstructive surgery on the mammary gland, there is often a desire to “tidy up” the healthy mammary gland, if there is an omission, there is a desire to reduce or increase the size of the bust.
One of the reasons why many agree to this is the reluctance to subsequently undergo another anesthesia, when it will be necessary to carry out surgical breast lifting, its reduction or increase.
How can a removal be carried out?
Until recently, it was believed that removal of the mammary gland was optimal at first, and reconstructive surgery only a year after mastectomy.
Some surgeons are still convinced that this is the best way to prevent the development of metastases and cancer recurrence. But not all patients psychologically just wait so long. For some, a physical defect becomes so significant that even the fact of getting rid of cancer is no longer pleasing.
Family relationships are getting worse. According to a number of reports by European authors of opinion polls and studies, in the first two years after a mastectomy, 70% of marriages break up. As a result, there is no disease, but the quality of life allows us to wish for the best.
Therefore, in most cases, reconstruction is now performed simultaneously with the removal of the mammary gland, if there are no serious health problems and contraindications to extended surgery.
How soft tissue is restored in the area of the removed breast
There are several options for restoring tissue volume in the area of mastectomy.
An expander can be used.
The expander is a special device that is installed in the field of breast reconstruction for a period of 3 to 6 months. It stretches the skin and forms a cavity sufficient for subsequent placement of the implant. Expanders are on the list of products offered by most companies engaged in the production of breast implants. The two-stage use algorithm and the breast implant are shown in the video.
It is installed under the skin and for a certain time is filled with liquid. Fluid is injected using a syringe. The procedure is performed on an outpatient basis.
Benefits of using an expander:
- much less traumatic surgery compared to transplantation of a musculocutaneous flap;
- the final volume of skin needed for breast reconstruction is achieved twice as fast as when using a vacuum system.
Disadvantages of using an expander:
- The need for frequent visits to the doctor for injections;
- The unnaturalness of the chest externally and to the touch;
- There is a risk of tissue necrosis (necrosis) over the expander if the skin is stretched too quickly;
- The implant is located directly under the skin, because there is a risk of the rapid development of ptosis, there are restrictions on the use of a number of implants in terms of gel density, so that the final result is as close to natural as possible.
A vacuum device can be used to form excess skin in the area where breast reconstruction is planned. For such cases, the Brava system has been developed. You need to wear it for a long time. Every day, to get the desired result, you need to use it for 10-12 hours.
The essence of the method is that a special cup shaped like a dome is put on the area of the mammary glands. A vacuum is created under the bowl, due to which the skin is constantly in a tense state and gradually stretches.
The advantages of the method are:
- performed simultaneously with liposuction;
- the method allows the use of implants and transplanted own fat to restore the volume of the mammary gland;
- if transplantation of adipose tissue is used, then there is no scarring.
The disadvantages of the method are that:
- you need to wear a special device on your chest for many months;
- it is difficult to achieve significant breast stretching to a large implant size;
- there is a risk of stretch marks and vascular mesh.
The whole technique consists of three stages:
1 stage – preparatory. It consists in wearing the vacuum system for a certain period of time every day for 10-12 hours. The system can be worn both day and night.
2 stage – transplantation of adipose tissue. Fat is taken from places where it is usually abundant by liposuction. Adipose tissue is injected into the chest area.
3 stage – final. The Brava system must be worn for another 3-4 weeks in order to increase the survival rate of the displaced adipose tissue.
Musculoskeletal flap transplant
The flap can be transplanted from the back (latissimus dorsi), or the anterior abdominal wall (rectus abdominis).
Advantages of the technique:
- mammary gland, natural in shape and touch;
- There are no problems associated with the use of implants, such as displacement of the implant, the need for replacement.
- prolonged anesthesia (4-5 hours);
- very high trauma operations;
- long period of rehabilitation;
- there is a risk of necrosis of the transplanted skin-muscle flap and its subsequent rejection;
- significant postoperative scars.
To restore the breast, a skin flap from the buttock, abdomen or back and an implant are used.
Restoration of soft tissue around the removed mammary gland.
If an extended operation is performed to remove not only the mammary gland, but also the adjacent soft tissues of the breast, then during the reconstruction it is necessary to restore their missing volume from the side of the surgical intervention.
Recovery is usually performed by transplantation of adipose tissue, which is taken from those places where it is surplus.
Ways to restore the nipple-areolar complex
Without restoration of the nipple and areola, breast reconstruction will be considered incomplete, since it is important for a woman to look good both in clothes and without her.
The main ways to recreate the nipple and areola are three:
- the areola is recreated from the areola tissue from a healthy side;
- the skin of the labia minora is transplanted if it is pigmented;
- the nipple is formed from the tissues of the restored mammary gland, and the areola is pigmented by tattooing.
Second Breast Correction
In order to eliminate asymmetry, improve the shape of a healthy breast, a large number of methods are used:
- mastopexy with breast augmentation by endoprosthesis;
- mastopexy with breast reduction.
Such methods are less commonly used, such as breast lift by threads, the use of fillers.
Contraindications for surgery
- the presence of infectious diseases;
- the presence of a tumor process of any stage and localization;
- serious diseases of the internal organs, in which their function is impaired;
- impaired blood clotting;
- age of 18 years;
- less than a year from the end of lactation;
- general severe condition of the patient;
- doubts about the necessity and feasibility of reconstructive surgery on the part of the patient.
Preparing for an operation
- surgeon consultation;
- laboratory and instrumental examinations to identify possible contraindications to surgery;
- it is forbidden to take alcohol two weeks before the operation, as this can lead to problems with anesthesia and withdrawal from it;
- It is recommended to quit smoking at least two months before the operation, especially if transplantation of skin-muscle flaps is planned to prevent problems with delayed healing and necrosis.
- necrosis of a skin flap or skin over an expander;
- delayed healing;
- complications associated with the wearing of implants (capsular contracture, rotation and displacement of the implant, and others).
The time required for the body to fully recover from the operation depends on the volume of the operation itself. If we talk about the Brava method, then this is the least traumatic method, which requires a hospital for a maximum of three days at the time of liposuction and transplantation of adipose tissue.
Full recovery occurs after 2-3 weeks after surgery and does not require any restrictions, except for a ban on thermal procedures. The use of expanders and endoprostheses essentially involves two operations. During the first, an expander is installed, during the second it is removed and replaced with an implant.
After each of the operations, there is a need to limit loads, take painkillers, comply with the ban on thermal procedures and sunbathing. After implant placement, wearing compression underwear is recommended.
The rehabilitation period is about 4 weeks. If we are talking about the formation of the mammary gland by the method of moving the musculoskeletal flap, then the rehabilitation period is often difficult and long.
After such an operation:
- the period of stay in the clinic is about 10-14 days;
- stitches are removed on 14 day;
- intense pains are possible, which gradually subside towards the end of the rehabilitation period;
- a ban on weight lifting and intense physical activity for a period of at least 6 months;
- wearing a bandage or compression underwear for at least six months after surgery;
- avoidance of sexual activity for 3-6 weeks after breast reconstruction.
The recovery period in this case can be from 6 weeks.